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Carrying Angle of Elbow

The carrying angle of elbow is a natural anatomical feature that describes the angle between the upper arm and forearm when the arm is extended and fully supinated (palm up). This angle allows for optimal function and range of motion in daily activities, such as carrying objects and performing various tasks.

Understanding the carrying angle can provide insights into joint stability, mechanics, and potential deviations that may occur due to injury or underlying conditions.

Carrying Angle Measurement

Various techniques have been described for measuring the cubital angle (carrying angle) of the elbow joint. The humerus-elbow-wrist angle of Oppenheim, which is somewhat more accurate than the humeroulnar angle, has become well established in the planning of corrective osteotomies and as a follow-up parameter in clinical studies.

The Baumann angle can be used in children to make an approximate, indirect measurement of the joint axis in cases where the joint cannot be examined in full extension because of injury or immobilization.

See Also: Baumann Angle
Carrying Angle

Humerus-Elbow-Wrist Angle of Oppenheim:

The humerus-elbow-wrist (HEW) angle of Oppenheim is determined on an anteroposterior (AP) radiograph of the arm with full elbow extension (180°) and supination. The radiograph should cover the arm from the proximal humerus down to the wrist.

The angle is measured between the humeral shaft axis and the forearm axis. The humeral shaft axis is defined by the midpoints of two lines perpendicular to the shaft spaced as far apart as possible. The forearm axis is defined by the midpoints of two lines perpendicular to the forearm bones (lateral border of the radius and medial border of the ulna).

Carrying Angle - Humerus-Elbow-Wrist Angle of Oppenheim

Carrying Angle Values

Mean value:10°
Cubitus varus:< 5°
Cubitus valgus:> 15°

Because the cubital angle is highly variable, a radiograph of the healthy side should always be obtained for comparison when planning a corrective osteotomy. If the affected elbow cannot be fully extended, the radiograph should be taken in maximum possible extension and the comparison view taken with the healthy limb in the same position.

Humeroulnar Angle:

The humeroulnar angle is measured on the AP radiograph of the arm or elbow joint. As the ulna often has some degree of curvature, especially in children, the accuracy of the measurement can be increased by displaying the entire ulna and entire humerus on one radiograph. The radiograph should be taken with full elbow extension (180°) and supination.

The humeroulnar angle is measured between the axes of the humeral and ulnar shafts. Ideally, both axes are drawn through the midpoints of two lines perpendicular to the shaft that are spaced as far apart as possible.

If the radiograph displays only the bone segments dose to the joint, the humeral axis can be defined by reference points placed at the level where the metaphysis begins to flare and at the distal diaphysis. The ulnar shaft axis is defined by two proximal reference points at the level of the proximal ulnar border and the radial tuberosity.

Humeroulnar Angle

Mean value in females (after Keats):13°
Mean value in males (after Keats):11°

The normal values stated in the literature vary considerably owing to differences in methodology, population size, and the variability of the carrying angle. Thus, comparison with the opposite side (=treatment goal) is essential for surgical planning. As a general rule, the angle is slightly greater in females than in males and also increases by a few degrees from childhood to adulthood.

References

  1. Beals RK. The normal carrying angle of the elbow. A radiographic study of 422 patients. Clin Orthop Relat Res. 1976 Sep;(119):194-6. PMID: 954311.
  2. Compensation for the effect of soft tissue artefact on humeral axial rotation angle – Scientific Figure on ResearchGate. Available from: https://www.researchgate.net/figure/Definition-of-the-carrying-angle_fig3_38026057 [accessed 21 May, 2023]
  3. Oppenheim WL, Clader TJ, Smith C, Bayer M. Supracondylar humeral osteotomy for traumatic childhood cubitus varus deformity. Clin Orthop Relat Res. 1984 Sep;(188):34-9. PMID: 6467726.
  4. Keats TE, Teeslink R. Diamond AE, Williams JH. Normal axial relationships of the major joints. Radiology 1966;87(5):904-907.
  5. Acton JD, McNally MA. Baumann’s confusing legacy. Injury 2001;32(1):41-43.
  6. Baumann E. Beitr:ige zur Kenntnis der Frakturen am Ellenbogengelenk. Allgemeines und Fractura supracondylica. Beitr Klin Chir 1929;146:1-50.
  7. Williamson DM, Coates CJ, Miller RK, Cole WG. Normal characteristics of the Baumann (humerocapitellar) angle: an aid in assessment of supracondylar fractures. J Pediatr Orthop 1992;12(5):636-639.
Last Reviewed
May 21, 2023
Contributed by
OrthoFixar

Orthofixar does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice.

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